Provider Demographics
NPI:1932557279
Name:EDGAR, ANGELA MARIE
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:EDGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14335 SW 120TH ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14335 SW 120TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7294
Practice Address - Country:US
Practice Address - Phone:786-329-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor